Distal Radius Fractures: A Clinical Casebook

Abstract

Distal radius fractures, particularly metaphyseal fractures, are common injuries in pediatric populations. Treatment decisions are made taking into account deformity, physeal involvement, articular involvement, mechanism of injury, other coexisting injuries, and the amount of growth remaining or potential for remodeling. Torus and minimally displaced distal radius fractures are stable injuries that tend to do well with nonoperative management, even without long-term immobilization or follow-up. Many displaced fractures may be treated with closed reduction, immobilization, and serial clinical evaluation and radiographs. The quality of the reduction and casting technique are likely more important than the specific type of immobilization when treating these fractures nonoperatively. There are not clear prognostic criteria for which pediatric distal radius metaphyseal fractures require operative intervention; however, factors associated with fracture redisplacement include initial displacement, fracture obliquity, direction of angulation, quality of initial reduction, and the experience of the individual performing the reduction. When surgical management is indicated, meticulous surgical exposure and delicate tissue handling are paramount for avoiding iatrogenic injury to the physis, periosteum, and perichondrium. Regardless of whether nonoperative or surgical management is pursued, meticulous technique and a thorough knowledge of pediatric anatomy and bone physiology are crucial for avoiding poor outcomes including permanent deformity or premature physeal closure.